Explaining Radiotherapy Boosts Patient Satisfaction, Reduces Anxiety

Liam Davenport

October 25, 2022

SAN ANTONIO — Patients with cancer who were given an appointment with a medical physicist to explain radiotherapy before they started this treatment showed lower levels of anxiety and expressed greater overall satisfaction with their treatment than the control group of patients who didn't have such an appointment.

This research "shows us that expanding the scope of the medical physics profession to include these new patient-facing responsibilities allows us to add more value to the field and provide better care for patients," commented lead author Todd F. Atwood, PhD, senior associate division director of Transformational Clinical Physics at the University of California San Diego.

The findings come from a phase 3 trial that was presented here at the American Society for Radiation Oncology (ASTRO) Annual Meeting 2022 on October 23, and published simultaneously in the International Journal of Radiation Oncology, Biology, Physics.

As the field of radiation oncology has evolved, so has the role of the medical physicist, Atwood commented at a press briefing. Originally, the focus was on the design and delivery of safe and effective therapy, he added, but the question now is more about 'How can we improve patient care?' "

More and more patients, not just those receiving radiation therapy, are looking for ways to be more involved in their care, and yet the information available to them is often "too complex," he said.

Another aspect is that "patient-related distress can negatively impact outcomes following radiation therapy," he commented, and this has created a "pretty unique story: We have patients who want to do more, they go searching for this information that leads to confusion or anxiety, and that distress can negatively impact outcomes."

"So we saw this as an opportunity for us as medical physicists to utilize our skill sets to see how we can make a difference."

The researchers launched the Physics Direct Patient Care (PDPC) Initiative, which aimed to establish an independent professional relationship with the patient while taking ownership of all technical aspects related to patient care.

Following a successful pilot study and phase 2 trial, the team launched the current phase 3 study, in which 66 patients due to undergo radiation therapy were randomly assigned either to PDPC or a control arm with a standard radiation oncology workflow.

The two treatment groups were well balanced in terms of gender, patient health literacy, and the treatment intent of the radiation therapy. The most common treatment sites were the breast, gynecologic targets, and the prostate.

Patients in the PDPC group had a physicist consult directly before their CT simulation appointment, and a second consult directly prior to the first treatment appointment.

During this consult, the medical physicists explained technical aspects of the radiation therapy, including how, following the CT simulation, the information gathered "was used to help us delineate the targets as well as all the organs at risk," Atwood explained. Patients would also be told about dose distributions and the need for multiple angles to maximize radiation delivery while minimizing toxicity, as well as the role of imaging in achieving that.

"We would go into detail on everything that goes into treatment planning and treatment delivery, in order to create a personalized therapy", he added.

Patients completed questionnaires at baseline, after the CT simulation, after the first treatment, and just after the last treatment to assess anxiety, technical satisfaction, and overall satisfaction.

The results showed that, compared to the control group, patients assigned to PDPC had lower scores on the State-Trait Anxiety Inventory at the time of the CT simulation, after the first treatment, and after the last treatment. The difference was statistically significant at the time of the first treatment (P = .027).

Moreover, the results showed that fewer patients reported high anxiety in the PDPC group (17%) vs standard care group (40%) after the first treatment, (P = .053), and this difference reached statistical significance after the last treatment, at 12% vs 39% (P = .047).

Technical satisfaction, as measured with a tool devised for the study, was significantly greater with PDPC vs standard care at the CT simulation appointment (P = .005), after the first treatment (P < .001), and after the last treatment (P = .002).

Overall satisfaction, which Atwood explained "is something that hospital systems administrators constantly note to really gauge the overall patient experience," was  significantly higher with the intervention after the first treatment (P = .014), and after the final treatment (P = .001).

Atwood acknowledged that these results come from a single institution, and so they "may not be generalizable," as other institutions may have "different departmental cultures, radiation oncologists, medical physicists, and patient populations."

No funding for this study was declared. Atwood reports relationships with Varian Medical Systems and Siris Medical.

American Society for Radiation Oncology (ASTRO) Annual Meeting 2022: Abstract 7. Presented October 23, 2022.

Int J Radiat Oncol Biol Phys. Published October 23, 2022. Abstract

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